Pathways Towards Prevention—Stakeholders’ Perspective in Eliminating Obstetric Fistula in Seharti District, Tigray, Ethiopia

Introduction and Hypothesis Multifaceted interventions, within Project Zero, are aimed at preventing obstetric fistula through community engagement, capacity building, patient identification and treatment, and strengthening maternal health care services. Although these approaches are promising, effectiveness in practice depends on underexplored contextual factors. Understanding stakeholders’ perspectives is essential for identifying factors that influence the effectiveness of interventions. The goal is to explore contextual factors affecting the implementation of a multifaceted intervention with the purpose of eliminating obstetric fistula from the perspectives of key stakeholders. Methods A qualitative study was conducted using semi-structured individual interviews ( n = 27) and focus group discussions ( n = 6) with purposively selected stakeholders, including health care personnel, midwives, health extension workers, community leaders and beneficiaries, and the data were analysed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Results Stakeholders identified key contextual factors influencing intervention effectiveness in 1 overarching theme, 4 themes and 11 sub-themes, such as raising awareness and promoting health-seeking behaviour, capacity building and mentorship of health care personnel, midwives’ leadership in monitoring and managing maternal care, accessibility of services, including free transportation and referrals, and multisectoral collaboration and community engagement. Effective implementation relied on combining community education, health-system strengthening, and supportive referral pathways. Conclusions Preventing obstetric fistula requires holistic and integrated interventions that address both social determinants and health system limitations. Sustainable impact depends on community-informed approaches integrated into existing the maternal health system, strengthened workforce capacity, midwifery leadership and improved access to maternal health services.